New daily persistent headache (NDPH) is a type of headache disorder that starts abruptly and continues daily for at least 3 months. Usually, people with NDPH can clearly recall the exact moment or date when the pain began.
The pain may resemble a tension headache, a migraine headache, or a mixture of the two. Doctors tend to diagnose NDPH if someone does not meet the criteria for another type of headache disorder, and there is no underlying cause for the pain.
This article looks at NDPH, including its symptoms, treatments, and other potential causes for a daily headache.
NDPH is a primary headache disorder, which means it does not occur due to another health condition. It is rare but can be debilitating. A unique characteristic of the disorder is that the person usually recalls the specific date or onset of the first headache.
After onset, the headache becomes persistent within 24 hours. Further headaches then continue daily for an extended period of time. Often, NDPH occurs in people who have no previous headache history. In around half of cases it begins following an illness or surgery, but there is often no clear trigger associated .
NDPH is more common in people with a close family member who experiences chronic headaches and two to three times more common in females, though the reasons for this are unclear.
NDPH is different from a persistent headache a person might experience due to another illness, although the symptoms can be similar.
The symptoms of NDPH can include features similar to tension-type headaches, migraine, or a mixture of both. A person may experience:
- mild to severe pain
- constant throbbing or pulsating pain
- pain on one or both sides of the head
- pain that worsens after physical activity
- sensitivity to sound, light, or smells
- nausea or vomiting
Symptoms of NDPH can resemble other medical conditions, so it is important for a doctor to rule out other causes. There is no specific test for NDPH, so doctors diagnose it through a process of elimination.
During an appointment, a doctor will take someone’s medical history, ask about their symptoms and onset, and then order some tests. These may include:
- blood tests to rule out inflammatory, infectious, or metabolic conditions
- medical imaging of the brain or blood vessels
- lumbar puncture
If a person meets the criteria for NDPH and doctors find no other underlying cause, they may receive an NDPH diagnosis.
NDPH is poorly understood, and there is no single way of treating it. Currently, doctors often recommend treatments for reducing pain based on the type of headache the pain most resembles, out of migraine or tension-type.
Some of the medications that may help include:
- antidepressants that target pain receptors, such as nortriptyline and amitriptyline
- antiseizure medications, such as topiramate
- blood pressure medications, such as candesartan
A 2019 systematic review notes that studies have also looked at an anti-inflammatory medication called methylprednisolone, tetracycline antibiotics, nerve blocking drugs, and Botox injections for treating NDPH. Most of these studies were small, but suggest these options have some promise. More research is necessary to confirm how well they work across a larger number of people.
Due to the possibility of a medication-overuse headache developing, people should try to avoid relying on short-term medications to manage NDPH, such as over-the-counter (OTC) pain relievers. Medications, such as barbiturates and opioids are addictive, so doctors should avoid prescribing them.
Complementary therapies, such as biofeedback and relaxation techniques, may help people reduce or cope with their daily symptoms.
NDPH can resemble other conditions. These include:
Migraine is a neurological condition that can cause moderate-to-severe headaches. A person with chronic migraine experiences headaches for more than 15 days out of every month and has a full migraine episode or uses pain medication for at least 8 of those days.
The symptoms of chronic migraine that people experience include:
- headache, often on one side of the head
- sensitivity to light, sounds, or smells
- nausea or vomiting
Some people also experience temporary sensory disturbances before the pain begins. These are known as aura.
Treatment can involve people taking prescription medications to stop symptoms progressing, which reduces the frequency of headaches. Some people also find it helpful to try supplements, such as magnesium, acupuncture, or biofeedback.
Chronic tension-type headache
A chronic tension-type headache occurs when a person has tension-type headaches for at least 15 days each month. Tension headaches cause different symptoms to migraine. These include:
- pain similar to the feeling of a tight band around the head
- feeling there is a weight on top of the head
- pressure or aching around the head
- neck or shoulder pain
Usually, tension-type headache pain is mild to moderate and does not get worse if a person is physically active.
People with occasional tension headaches can use OTC pain medications, but if someone experiences these headaches more frequently, using OTC pain medications more often may cause adverse effects. Preventative approaches, such as amitriptyline, massage, physical therapy, or biofeedback may help people to manage the condition.
Hemicrania continua is a rare, chronic headache condition that causes continual mild-to-moderate pain on one side of the head. Often, people also have periods of severe pain, as well as other symptoms. These may include:
- watery eyes
- red eyes
- stuffy or runny nose
- drooping eyelid
- sound, light, and smell sensitivity
The most common treatment for hemicrania continua is indomethacin, a non-steroidal anti-inflammatory drug (NSAID). It is the only type of NSAID that works for this condition. NSAIDs can cause adverse side effects, so people who cannot tolerate indomethacin may need to explore other options.
A persistent headache can be an initial symptom of COVID-19. Research suggests that headaches may present in anywhere between 14–60% of people with COVID-19.
A headache due to COVID-19 may develop fairly suddenly and persist each day until a person recovers. Most people experience mild, short-term illness and recover in
In some cases, people with COVID-19 develop ongoing symptoms after the initial infection, which can last weeks or months. This is known as long COVID or long-haul COVID. People can develop long COVID even if their initial COVID-19 symptoms were mild, and headaches are a potential symptom. People with pre-existing migraine may also experience worse or more frequent episodes.
If someone develops a new persistent headache and could have COVID-19, they should stay at home and find out from their local health authority how to get tested.
Anyone with a new daily headache should speak with a doctor. Headaches that persist can be a symptom of many conditions, some of which need treatment.
If a person has any of the following, they should call 911 or their local emergency department:
- a sudden, severe headache that feels worse than ever
- a headache, neck stiffness, and a rash that does not disappear under glass
- a headache along with sudden blurry vision, slurred speech, or paralysis
- a headache along with shortness of breath, blue or white lips and nails, confusion, or difficulty staying awake
- a persistent headache following a blow to the head, particularly if there are other symptoms, such as drowsiness, confusion, or changes in behavior
New daily persistent headache (NDPH) is a primary headache disorder that involves chronic, persistent headaches that occur daily for at least 3 months. Usually, people can recall the exact onset of their first headache. In some cases, it begins after an infection or surgery.
Primary headache disorders are not associated with any underlying condition. However, a persistent, chronic headache can also be a symptom of another condition besides NDPH. These include chronic migraine, COVID-19, and long COVID. People who experience long lasting or daily headaches should contact a doctor.